HomeMy WebLinkAbout3444 Bale Dr - Applications/Furnace - 12/29/2017City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mebile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellei Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ' `I W a� Date 12129i2017
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3444 Bale Drive
52,817.00
Property Owner Name Address
City/State Zip
Phone
Natalya Volchanskaya 3444 Bale Drive
Fort Collins, CO 80526
443-8010
Applicant Name Address
City/State Zia
Phone
Natalya Volchanskaya 3444 Bale Drive
Fort Collins. CO 80526
443-8010
Contractor Address
City/State Zip
Phone
DC Shonridge dba Gary Hg 1314 Webster Avenue
Fort Collins. CO 80524
493-3272
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
O Here ❑ Report
Saleshxnumber isrequiredbyall rontractors.
Are you paying with your trust account?
[J Yes ❑ No
34734
Is this a residential or commercial project? LD Residential 0 Commercal
If residential, is it: O Single Family Detached 9 Condo/townhome (single family attached) ® Duplex
13 Multifamily (apartment) B Garage
If commercial, is it: 9 Bank 11 Bar ❑ Church 8 Hotel/Motel ❑ Medical office ID Office ❑ Retail
O Restaurant Cl Other (explain')
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Presemation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replacing furnace with a tv o stage 800.f, efficient furnace
"If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins License
Electrician __ Plumber __. Mechanical H-1654 _ Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree :o
comply with all requirements contained herein and city ordinances and sate laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: Shell Swanson IV-, 1 / ff
Print Name: y SSignature t 1 1 f . j'1 . ,1 . 1 r Date